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Kazunori Kihara M.D., Ph.D. Associate Editor

This issue, which opens with a greeting from the new Editor-in-Chief, contains one guideline and five original articles of considerable interest covering a wide variety of topics.

The guideline, by Hamasuna et al. (Kitakyushu, Japan), is concerned with the prevention of health care-associated infection in urological practice in Japan. The transmission of pathogens within the health care setting is a crucial problem worldwide, and reducing the risk of such transmission is a matter of great importance. The purpose of this guideline is to spell out the minimum precautions that urologists and other medical professionals should observe when they work in the urological field. By surveying the literature, including standard precautions, environmental considerations, the management of urinary catheters, endoscopy techniques, and the disinfection and sterilization of instruments, this practical guideline addresses issues in three major categories: (i) infection control in the urological ward; (ii) infection control in outpatient urology and urological procedures; and (iii) aseptic technique and disinfection/sterilization of urological endoscopes.

In living-donor nephrectomy, it is important for surgeons to be aware of possible anatomical variations of the posterior lumbar tributaries of the left renal vein in order to avoid vein damage and to obtain a longer renal artery. Li et al. (Beijing, China) are the first to report seven types of anatomical variations, including five main types, as well as the less common reno-hemi-azygo-lumbar trunk (AZV) type. Breakdown by the number of posterior lumbar tributaries was zero (16.4%), one (47.5%), two (32.8%) and three (3.3%). Operation time during the process of managing posterior lumbar veins was longest in the AZV type and shortest in the zero-lumbar-vein type.

The use of drugs to facilitate the spontaneous passage of urinary tract stones, one of the most common urological diseases worldwide, has recently become popular. α-Blockers are considered to be the most effective drugs for medical expulsive therapy (MET), but have not yet been sufficiently evaluated. Chau et al. (Hong Kong, China) assessed the spontaneous passage rate for patients presenting with an acute ureteral stone (size 5–10 mm) who were treated with alfuzosin, an α-blocker, at a dosage of 10 mg daily. The overall spontaneous passage rate was 31.8% higher in alfuzosin-treated patients than in the control group. For upper ureteral stones, the rate was 51.3% higher. The MET group also required significantly fewer analgesic drugs.

Drugs used for the treatment of erectile dysfunction (ED) have also recently begun to receive attention as possible agents for the treatment of BPH-LUTS. Maselli et al. (L'Aquila, Italy) compared tadalafil (PDE5-I) with solifenacin (an antimuscarinic agent) as treatments for persistent storage symptoms after prostate surgery in patients with ED. In this prospective randomized study, tadalafil (5 mg) given once daily for 12 weeks resulted in an improvement in the International Prostate Symptoms Score comparable to that of solifenacin (5 mg) given for the same period of time.

Patients with hypospadias, a common urogenital abnormality, are reported to have a higher prevalence of vesicoureteral reflux (VUR), but the clinical course of such cases remains unclear. Kim et al. (Seoul, Korea) observed VUR in 12.1% of hypospadias patients and in 21.8% of hypospadias patients younger than 1 year-of-age. Follow-up voiding cystourethrography was carried out in 30 patients, showing resolution of reflux in 27 patients and improvement in the remaining three. They concluded that it is not necessary to screen for VUR in hypospadic patients, because it resolves spontaneously in most cases.

Bladder instillation has been a common treatment modality for cystitis-related overactive bladder (OAB) symptoms. Coating the inner surface of the bladder with glycoproteins is believed to help prevent further inflammation of the bladder. Ho et al. (Pu-Z City, Taiwan) investigated the effect of hyaluronic acid (HA), a glycoprotein, on nerve growth factor (NGF) production and bladder overactivity in a cyclophosphamide (CYP)-induced cystitis rat model. In the CYP-induced groups, bladder HA instillation significantly increased the intercontraction interval and decreased urine NGF production.